Individual provider · NPI-1

Donnita Kaye Jackson

Residential Treatment Facility, Physical Disabilities · Austin, TX

NPI number1689924433
StatusActive
Last updated in NPPESSep 12, 2013

Details

NPI
1689924433
Entity type
Individual (NPI-1)
Name
Donnita Kaye Jackson
Sex
Female
Sole proprietor
Yes
Enumeration date
Sep 19, 2012
Last updated
Sep 12, 2013

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
320700000X Residential Treatment Facility, Physical Disabilities––Yes

Practice location

1210 South Trace
Austin, TX 78745

Phone 512-888-5985

Mailing address

1210 South Trace
Austin, TX 78745

Phone 512-888-5985

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